电子病历中索赔数据对成人先天性心脏病的识别和分类的准确性。
Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records.
机构信息
Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France.
Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France; Department of Medical Informatics and Public Health, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
出版信息
Arch Cardiovasc Dis. 2019 Jan;112(1):31-43. doi: 10.1016/j.acvd.2018.07.002. Epub 2019 Jan 3.
BACKGROUND
The content of electronic medical records (EMRs) encompasses both structured data, such as billing codes, and unstructured data, including free-text reports. Epidemiological and clinical research into adult congenital heart disease (ACHD) increasingly relies on administrative claim data using the International Classification of Diseases (9th revision) (ICD-9). In France, administrative databases use ICD-10, the reliability of which is largely unknown in this context.
AIMS
To assess the accuracy of ICD-10 codes retrieved from administrative claim data in the identification and classification of ACHD.
METHODS
We randomly included 6000 patients hospitalized at least once in 2000-2014 in a cardiology department with a dedicated specialized ACHD Unit. For each patient, the clinical diagnosis extracted from the EMR was compared with the assigned ICD-10 codes. Performance of ICD-10 codes in the identification and classification of ACHD was assessed by estimating sensitivity, specificity and positive predictive value.
RESULTS
Among the 6000 patients included, 780 (13%) patients with ACHD were manually identified from EMRs (107,092 documents). ICD-10 codes correctly categorized 629 as having ACHD (sensitivity 0.81, 95% confidence interval 0.78-0.83), with a specificity of 0.99 (95% confidence interval 0.99-1). The performance of ICD-10 codes in correctly categorizing the ACHD defect subtype depended on the defect, with sensitivity ranging from 0 (e.g. unspecified congenital malformation of tricuspid valve) to 1 (e.g. common arterial trunk), and specificity ranging from 0.99 to 1.
CONCLUSIONS
Administrative data using ICD-10 codes is a precise tool for detecting ACHD, and may be used to establish a national cohort. Mining free-text reports in addition to coded administrative data may offset the lack of sensitivity and accuracy when describing the spectrum of congenital heart disease using ICD-10 codes.
背景
电子病历（EMR）的内容既包括结构化数据，如计费代码，也包括非结构化数据，包括自由文本报告。成人先天性心脏病（ACHD）的流行病学和临床研究越来越依赖于使用国际疾病分类（第 9 版）（ICD-9）的行政索赔数据。在法国，行政数据库使用 ICD-10，但其在这种情况下的可靠性在很大程度上是未知的。
目的
评估从行政索赔数据中检索的 ICD-10 代码在识别和分类 ACHD 中的准确性。
方法
我们随机纳入了 2000 年至 2014 年期间在心脏病科住院至少一次的 6000 名患者，该科室设有专门的 ACHD 专科。对于每位患者，从 EMR 中提取的临床诊断与分配的 ICD-10 代码进行比较。通过估计敏感性、特异性和阳性预测值来评估 ICD-10 代码在识别和分类 ACHD 中的性能。
结果
在纳入的 6000 名患者中，从 EMR 中手动识别出 780 名（13%）患有 ACHD 的患者（107092 份文件）。ICD-10 代码正确分类了 629 例为 ACHD（敏感性 0.81，95%置信区间 0.78-0.83），特异性为 0.99（95%置信区间 0.99-1）。ICD-10 代码正确分类 ACHD 缺陷亚型的性能取决于缺陷，敏感性范围从 0（例如，三尖瓣未特指的先天性畸形）到 1（例如，共同动脉干），特异性范围从 0.99 到 1。
结论
使用 ICD-10 代码的行政数据是一种精确的工具，可以用于检测 ACHD，并且可以用于建立一个全国性的队列。除了编码的行政数据之外，挖掘自由文本报告可以弥补使用 ICD-10 代码描述先天性心脏病谱时敏感性和准确性的不足。
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